Many persons with ADHD have successful careers and stable home lives. However, the sad reality for many people with ADHD is that the impulsiveness which defines their disorder puts them at risk of committing crimes. Study after study hammers out the unfortunate fact that persons with ADHD are more than twice as likely to be arrested compared with a control group without ADHD (42% vs 24%), three times more likely to be convicted (42% vs 14%), and 15 times more likely to serve time in jail (15% vs 1%). Up to 40% of prisoners have ADHD, and their recidivism rate is astoundingly high—up to two thirds are rearrested within three years. But a study out of Sweden published in the New England Journal of Medicine strongly suggests that older teens and adults with ADHD who are medicated are much less likely to commit a crime than those who are not medicated.
Because Sweden has a national health registry, researchers were able to compare the records of 26,000 patients who had been diagnosed with ADHD with those of individuals who had criminal convictions between 2006 through 2009. Researchers were able to use these records to determine if the person with ADHD were taking medicine at the time the crime was committed. Results were striking. They found that men with ADHD who were medicated were 32% less likely to commit a crime than men with ADHD who were not medicated, and women with ADHD were 41% less likely to commit a crime than women who were not medicated. Additionally, the researchers found that 37% of men with ADHD were convicted of committing at least one crime during this period compared with 9% of men without ADHD. (For women, the rates were 15% vs 2%).
This study echoes an earlier 2009 report from the National Bureau of Economic Research which offered a tantalizing insight into the effects of drug prescribing on overall crime rates between the years 1997 through 2004. Given that depression is frequently a co-morbid diagnosis with ADHD, researchers wanted to examine whether the prescribing of newer generation antidepressants as well as stimulants for ADHD affected crime rates. Indeed, researchers found that the overall crime rate declined when prescriptions for these drugs increased. To check their results, researchers looked at other prescriptions for non-related conditions and found no relationship between the number of prescriptions and the crime rate.
Dr. Paul Lichtenstein, an author of the Swedish study, is not prepared to make a blanket recommendation for prescribing stimulants to everyone with ADHD. The Swedish study was not a randomized, controlled study. There were a lot of variables that researchers could not control and even more information about the patients they did not have. For instance, researchers had no knowledge of whether alcohol abuse or supportive family members were present. Additionally, patients receiving prescriptions for ADHD medications were also likely to be receiving some form of mental health services, which may have lessened the likelihood of their committing crimes. But the overall results are suggestive enough for Dr. Lichtenstein to recommend that adolescents, who are already at a high risk of committing impulse crimes, should be medicated as well as should prisoners with ADHD or those exiting jails to lower their recidivism rates. The United Kingdom, incidentally, already tests automatically all prisoners for ADHD.
So what does this mean for children with ADHD? Some say it matters not at all--behavioral modification therapy can work just as well as medication. For many, however, it appears that these studies add additional fuel to the argument that medication, as part of an overall treatment plan, can make a difference for these children. It is more than understandable that parents struggle over the decision whether to medicate their children or not. Parents of course want their children to be able to attend effectively so that they can be successful at school as well as be able to develop healthy relationships with peers. But parents also know that stimulant medications are not side-effect free and may impair their child’s growth, appetite, or sleep. This new study, however, continues to provide further proof that not only are these medications effective, but also that the need for pharmacologic intervention for ADHD does not end when childhood ceases. The effects of this disorder follow children into adulthood.